Application of acupuncture in the emergency department for patients with ileus: A pilot prospective cohort clinical study.

Acupuncture can be conveniently used for pain control in patients with a variety of conditions, and it has obvious effects on various acute pains. In 2018, we implemented a program for emergency treatment with Chinese medicine to promote the integration of Chinese and Western medicine at the Emergency Department (ED). Ileus is a common cause of abdominal pain among patients in the ED, and it is an indication for emergency treatment with Chinese medicine. This study investigated the efficacy of acupuncture as a traditional Chinese medicine (TCM)-based treatment method for the treatment of patients with ileus in the ED. We analyzed data of patients with ileus, who visited ED between January and December 2019, and compared the length of ED stay between the Western medicine group and the Western medicine plus acupuncture group. Furthermore, pain intensity was measured by a visual analogue scale before and after acupuncture. We found that the length of ED stay was 10.8 hours lesser in the Western medicine plus acupuncture group than in the Western medicine group (P = .04), and the visual analogue scale score decreased by 2.0 on average from before to after acupuncture treatment (P = .02). Acupuncture treatment was effective and rapid in relieving the symptoms and discomfort in patients with ileus and in reducing their length of stay in the ED.

Factors Affecting the Cases and Deaths of COVID-19 Victims.

This paper attempts to find the factors that affect the number of cases and deaths of coronavirus disease 2019 (COVID-19) patients a year after the first outbreak in Wuhan, China. There were 141 countries affected with COVID-19 involved in the study. Countries were grouped based on population. Using ordinary least squares regression, it was found that the total number of cases and deaths were significantly related with the levels of population of the different countries. On the overall, median age of the country, and average temperature are positively related with the number of deaths from the virus. On the other hand, population density is positively related with the deaths due to COVID for low populated countries. The result of this preliminary study can be used as a benchmark for authorities in the formulation of policies with regards to treating COVID-19 related issues.

Tourism under the Early Phase of COVID-19 in Four APEC Economies: An Estimation with Special Focus on SARS Experiences.

This study examines how experience of severe acute respiratory syndrome (SARS) influences the impact of coronavirus disease (COVID-19) on international tourism demand for four Asia-Pacific Economic Cooperation (APEC) economies, Taiwan, Hong Kong, Thailand, and New Zealand, over the 1 January-30 April 2020 period. To proceed, panel regression models are first applied with a time-lag effect to estimate the general effects of COVID-19 on daily tourist arrivals. In turn, the data set is decomposed into two nation groups and fixed effects models are employed for addressing the comparison of the pandemic-tourism relationship between economies with and without experiences of the SARS epidemic. Specifically, Taiwan and Hong Kong are grouped as economies with SARS experiences, while Thailand and New Zealand are grouped as countries without experiences of SARS. The estimation result indicates that the number of confirmed COVID-19 cases has a significant negative impact on tourism demand, in which a 1% COVID-19 case increase causes a 0.075% decline in tourist arrivals, which is a decline of approximately 110 arrivals for every additional person infected by the coronavirus. The negative impact of COVID-19 on tourist arrivals for Thailand and New Zealand is found much stronger than for Taiwan and Hong Kong. In particular, the number of tourist arrivals to Taiwan and Hong Kong decreased by 0.034% in response to a 1% increase in COVID-19 confirmed cases, while in Thailand and New Zealand, a 1% national confirmed cases increase caused a 0.103% reduction in tourism demand. Moreover, the effect of the number of domestic cases on international tourism is found lower than the effect caused by global COVID-19 mortality for the economies with SARS experiences. In contrast, tourist arrivals are majorly affected by the number of confirmed COVID-19 cases in Thailand and New Zealand. Finally, travel restriction in all cases is found to be the most influencing factor for the number of tourist arrivals. Besides contributing to the existing literature focusing on the knowledge regarding the nexus between tourism and COVID-19, the paper's findings also highlight the importance of risk perception and the need of transmission prevention and control of the epidemic for the tourism sector.

Estimating the Threshold Effects of Climate on Dengue: A Case Study of Taiwan.

Climate change is regarded as one of the major factors enhancing the transmission intensity of dengue fever. In this study, we estimated the threshold effects of temperature on Aedes mosquito larval index as an early warning tool for dengue prevention. We also investigated the relationship between dengue vector index and dengue epidemics in Taiwan using weekly panel data for 17 counties from January 2012 to May 2019. To achieve our goals, we first applied the panel threshold regression technique to test for threshold effects and determine critical temperature values. Data were then further decomposed into different sets corresponding to different temperature regimes. Finally, negative binomial regression models were applied to assess the non-linear relationship between meteorological factors and Breteau index (BI). At the national level, we found that a 1°C temperature increase caused the expected value of BI to increase by 0.09 units when the temperature is less than 27.21 °C, and by 0.26 units when the temperature is greater than 27.21 °C. At the regional level, the dengue vector index was more sensitive to temperature changes because double threshold effects were found in the southern Taiwan model. For southern Taiwan, as the temperature increased by 1°C, the expected value of BI increased by 0.29, 0.63, and 1.49 units when the average temperature was less than 27.27 °C, between 27.27 and 30.17 °C, and higher than 30.17 °C, respectively. In addition, the effects of precipitation and relative humidity on BI became stronger when the average temperature exceeded the thresholds. Regarding the impacts of climate change on BI, our results showed that the potential effects on BI range from 3.5 to 54.42% under alternative temperature scenarios. By combining threshold regression techniques with count data regression models, this study provides evidence of threshold effects between climate factors and the dengue vector index. The proposed threshold of temperature could be incorporated into the implementation of public health measures and risk prediction to prevent and control dengue fever in the future.

Threshold Effects of PM2.5 Exposure on Particle-Related Mortality in China.

Ambient air pollution from energy use and other sources is a major environmental risk factor in the incidence and progression of serious diseases, such as cardiovascular and respiratory diseases. This study elucidates the health effects of energy consumption from air pollution in China based on multiple threshold effects of the population-weighted exposure to PM2.5 (fine particles less than 2.5 microns in diameter) on particle-related mortality rate. We firstly estimate the causal relationship between coal consumption and PM2.5 in China for 2004-2010 using a panel regression model. Panel threshold models are applied to access the non-linear relationships between PM2.5 and cause-specific mortality rates that indicate the health effects are dependent on the PM2.5 ranges. By combining these steps, we calculate the health impacts of coal consumption based on threshold effects of PM2.5. We find that a 1% coal consumption increase induces a 0.23% increase in PM2.5. A triple threshold effect is found between PM2.5 and cardiovascular mortality; for example, increasing PM2.5 exposure causes cardiovascular mortality rate to increase when PM2.5 lies in 17.7-21.6 µg/m3 and 21.6-34.3 µg/m3, with the estimated increments being 0.81% and 0.26%, respectively, corresponding to 1% PM2.5 increase. A single threshold effect of SO2 on respiratory mortality rate is identified and allows the estimation of the mortality effects of PM2.5 regarding the two regimes of SO2. Finally, we access the health impacts of coal consumption under specific estimated thresholds. This study provides a better understanding of sources contributing to related-air pollution mortality. The multi-threshold effect of PM2.5 could be considered for further applications in harmonizing emission standards in China and other developing countries.

The association between skull bone fractures and outcomes in patients with severe traumatic brain injury.

BACKGROUND: In traumatic brain injury (TBI), computed tomography (CT) provides a good assessment of anatomic pathologic findings and the prognostic value of CT characteristics has been well discussed. However, few studies have focused on skull bone fracture and its clinical prognostic importance. Hence, this study aims to evaluate the effects of skull bone fracture on patients with severe TBI admitted to the emergency unit. METHODS: We reviewed the medical records of patients with isolated severe TBI admitted to the emergency unit of a university hospital from July 2003 to June 2008. Patients were divided into two groups based on the presence of skull bone fracture identified by the CT scan while in the emergency unit. Mann-Whitney U test and a Student's t test were used to identify the differences between the two groups, whereas logistic regression was applied to determine any significant differences found in the statistical analysis. RESULTS: A total of 197 patients were signed up in our study. Based on the presence of skull bone fracture on CT scan at emergency department, 92 patients (46.7%) comprised the skull bone fracture group and 59 patients (64.1%) of these died. One hundred five patients (53.3%) comprised the nonskull bone fracture group, of which 33 patients (31.4%) died. There is significant difference between the two groups (p = 0.004). CONCLUSION: This study shows that skull bone fracture is a mortality risk factor for patients with isolated severe blunt TBI.

Estimating the economic impact of climate change on cardiovascular diseases--evidence from Taiwan.

The main purpose of this study was to investigate how climate change affects blood vessel-related heart disease and hypertension and to estimate the associated economic damage. In this paper, both the panel data model and the contingent valuation method (CVM) approaches are applied. The empirical results indicate that the number of death from cardiovascular diseases would be increased by 0.226% as the variation in temperature increases by 1%. More importantly, the number of death from cardiovascular diseases would be increased by 1.2% to 4.1% under alternative IPCC climate change scenarios. The results from the CVM approach show that each person would be willing to pay US$51 to US$97 per year in order to avoid the increase in the mortality rate of cardiovascular diseases caused by climate change.

Assessing impacts of SARS and Avian Flu on international tourism demand to Asia.

The purpose of this paper is to investigate the impacts of infectious diseases including Avian Flu and severe acute respiratory syndrome (hereafter SARS) on international tourist arrivals in Asian countries using both single datasets and panel data procedures. An autoregressive moving average model together with an exogenous variables (ARMAX) model are used to estimate the effects of these diseases in each SARS- and Avian Flu-infected country, while a dynamic panel model is adopted to estimate the overall impact on the region of these two diseases. The empirical results from both approaches are consistent and indicate that the numbers of affected cases have a significant impact on SARS-affected countries but not on Avian Flu-affected countries. However, since the potential damage arising from the Avian Flu and subsequent pandemic influenza is much greater than that resulting from the SARS, the need to take the necessary precautions in the event of an outbreak of Avian Flu and pandemic influenza warrants further attention and action. Therefore, the empirical findings of this study could add to the knowledge regarding the relationship between tourism and crisis management, especially in so far as the management of transmissible diseases is concerned.